The Role of Brand Communicators in an Outbreak

A lot of the work we do in healthcare marketing and communications is predictable. Brand-building, patient acquisition, and organizational support. But when a new health threat emerges, brand communicators have to respond quickly to help people minimize their risk of infection and to keep fear from spreading.

A lot of the work we do in healthcare marketing and communications is predictable. Brand-building, patient acquisition, and organizational support are long-haul types of activities that you sustain throughout the year. But when a new health threat emerges, brand communicators have to respond quickly to help people minimize their risk of infection and to keep fear from spreading unnecessarily.

That continues to be the case with the Novel Coronavirus (COVID-19), which emerged from the city of Wuhan and Hubei province in China. Authorities suppressed news of the initial cases, so when it finally hit the news cycle, it seemed to appear menacingly overnight. From that point on, the media coverage was almost breathless in its reporting on the quarantine of millions and disturbing visuals of jammed hospitals turning people away. Some of the images circulated online were haunting.

Fear Spreads Faster Than Facts

Even though the Centers for Disease Control and Prevention (CDC) worked quickly to understand how COVID-19 spreads and its mortality rate, people thousands of miles away from the epicenter began to fear for their safety.

At times like these, brand communicators must find facts from trusted sources, like the CDC, and disseminate it across multiple touchpoints. The information has to be pushed out assertively, because fear raises cognitive barriers that make it even harder to absorb information and assess risk within an appropriate context. For example, at the same time that COVID-19 was making headlines, millions in the U.S. had the flu, more than 100,000 hospitalizations would occur, and more than 12,000 would die from its complications. Yet we are so accustomed to the flu that we perceive its risk as less than the risk of something new.

Spread Facts

If you work in healthcare, you are part of a crisis response team with a responsibility to share evidence-based facts to combat fear and misinformation. The outbreak continues and our thoughts are with those who are impacted.

But with an ongoing dose of information, we can help reduce the spread of unnecessary fear and the spread of the virus. Learn more about COVID-19 from the CDC.

Healthcare Marketers Live in Multiple Worlds — Leverage That Insight

As healthcare marketers, you live in multiple worlds. Of course you are a professional. But every time you go to the doctor, you’re a healthcare consumer. And while your employer provides care to tens of thousands of people each year, it’s also one of the largest purchasers of health insurance coverage in your market.

As healthcare marketers, you live in multiple worlds. Of course you are a professional. But every time you go to the doctor, you’re a healthcare consumer. And while your employer provides care to tens of thousands of people each year, it’s also one of the largest purchasers of health insurance coverage in your market.

These multiple perspectives can be a strength as you build bridges among your audiences. Or they may frustrate you, because it adds nuance and complexity to the task at hand.

Let’s take a look at the duality of being both a provider of healthcare and a consumer of health insurance, with all of its rules and paperwork.

Hospitals are one of the largest employers in most communities. A hospital of 200 beds may employ as many as 1,400 full- and part-time benefit-eligible employees, while large facilities can top 5,000. Workforces of that size are diverse, with many roles that impact patient experience but don’t require familiarity with the intricacies of health insurance. But, hopefully, all of those employees are eligible for insurance and made their selections last fall for the 2020 coverage year.

Likewise, consumers who may have changed insurance or their doctor are beginning their patient experience journey. Perhaps, as a consumer yourself, you’ve taken one of your kids to a new doctor and experienced a little disorientation. What would have helped?

This is all to say that more often than you think, you have opportunities to see things through more than one lens. That recognition of the friction points can lead to real improvement in communications and brand experience.

Bring those insights to the table.

5 Ways Healthcare Marketers Can Prepare for Seat at the Table

Healthcare marketers, are you at the kid’s table or the grown-ups table? Whether in a small town or large city, your medical practice or hospital is impacted by external matters, such as zoning issues, health plan changes, and the national debate about healthcare access.

Healthcare marketers, are you at the kid’s table or the grown-ups table?

Whether in a small town or large city, your medical practice or hospital is impacted by external matters, such as zoning issues, health plan changes, and the national debate about healthcare access. Are you at the leadership table when these issues are made?

Historically — and even today, in some organizations — the marketing and communication function was seen as a “packager” of decisions made by others. This “take this and sell it” mindset can fail spectacularly when the stakes are high, forcing a series of clarifications that make the organization look uncoordinated.

A lack of upfront input from communications contributes to decisions that come across as tone deaf when messaged to the public or other influential audiences  In these situations, the communications function hasn’t failed, but leadership failed to anticipate the external response, because of a lack of communications input at the beginning.

The communications function should be a critical input to actual decision-making, especially when it impacts patients. Having communication professionals at the table can help operational leadership anticipate — and prepare for — criticisms and questions that will arise when major decisions are announced.

For this construct to work, however, the communications function needs to come to the table prepared. This requires five things:

  • Reading a broad array of consumer, medical, and policy publications to understand various perspectives on trending issues, as well as core ones;
  • Staying in contact with external audiences through original and third-party market research and participation in influencer events;
  • Anticipating likely questions and bringing well-developed FAQs to the table for solution development by the full leadership team with an emphasis on how the organization will help transition those who are negatively impacted;
  • Aligning (or internally pointing out misalignment) between a decision and the organization’s publicly stated mission, vision, values, and previous statements. In cases where they do not seem to align, be transparent about the considerations that led to the decision and any steps being taken elsewhere in the organization to lessen perceived harm; and,
  • Recognizing that the outcomes of issues management may impede progress on your carefully constructed strategic marketing framework, particularly if the issue lingers in traditional or social media.

Wishing you a happy holiday season and a seat at the grown-ups table.

How Hospitals Can Compare Prices, Despite Not Having a Consumerism Model

The inability to compare prices is an often-cited reason for why healthcare hasn’t fully evolved into a consumerism model — patients don’t comparison shop among healthcare providers, using price as a significant factor in decision-making like they do when comparing other purchases.

The inability to compare prices is an often-cited reason for why healthcare hasn’t fully evolved into a consumerism model — patients don’t comparison shop among healthcare providers, using price as a significant factor in decision-making like they do when comparing other purchases.

So when the Centers for Medicare and Medicaid Services (CMS) rolled out a regulation that required hospitals to post their “chargemaster” rates online, as of Jan. 1, 2019, it was another experiment in creating a more price-aware environment.

Nearly a year later, the introduction of chargemaster data into the public sphere has had no discernible impact on use. The structure and volume of chargemaster data made comparisons too difficult, and the results too generalized to be predictive of the costs an individual with insurance would incur.

  • So will pricing information ever become a significant part of consumer decision-making?
  • Yes, although it remains several miles down the road, and likely will stay limited to services with less likelihood of medical complications, which adds in additional services and costs.

The most likely source of the data will be health plans that can associate its member’s benefits and the rates defined in plan-provider contracts to provide an estimate.

If the plans take it one step further and compare facilities within a geographic radius to present consumers with options, will that influence choice? And should pricing be a determinant of choice when other factors, such as provider expertise and facility quality, are also considerations?

It can be helpful to think of the CMS’ requirement of January 2019 as a directional change that opens the door to greater pricing scrutiny. Chargemaster rates are like “list prices” in the same way a hotel has list prices, but guests rarely pay the full amount. But that rule was just the first in what is likely to be a series of rules under consideration that will gradually pull back pricing layers until they become meaningful at a consumer level.

One rule — under consideration, but not finalized — would force hospitals to make public their standard charges, including payer-specific negotiated prices, in a format that is both machine-readable and “consumer friendly.” That would represent a significant expansion on price transparency. Assuming this rule is challenged in court, implementation likely will be delayed past its proposed January 2020 effective date.

One thing is certain: The external environment is shifting on price transparency.

If you are unsure where your facility falls on the cost spectrum vs. competitors, a data analyst can compare chargemaster data as one way of establishing context. Armed with this information, you can open the door with leadership to discuss this coming chapter in price-based competition.

Healthcare Open Enrollment Means Marketers Ask: Whose Patient Are You, Really?

It’s Open Enrollment season in health care. Marketers at physician groups, hospitals, and health plans compete for attention and selection. These high-profile marketing campaigns tend to overshadow a new wrinkle that adds complexity behind the scenes — patient attribution.

It’s Open Enrollment season in health care. Marketers at physician groups, hospitals, and health plans compete for attention and selection because the choices made now will drive patient traffic and revenue potential over the coming year. These high-profile marketing campaigns tend to overshadow a new wrinkle that adds complexity behind the scenes — patient attribution.

Patient attribution is rising in importance as part of the overall shift toward Accountable Care Organizations (ACOs), value-based care, population health, and social determinents of health. All of these trends require a provider or provider’s organization to be more engaged, proactive, and mindful of resource utilization. In an HMO model, the responsiblity rests with the assigned or chosen primary care physician (PCP), known as a “patient choice” attribution method. The PCP does an initial evaluation and determines when more specialized care is appropriate. But this obvious direct accountability is not present in other types of coverage, where the healthplan design does not require the patient to choose a PCP. In these situations, patients can bounce from physician-to-physician and hospital-to-hospital, with only the insurance company having an understanding of the patient’s health situation — based on the claims they pay.

This is where patient attribution comes into play. The idea is that clear lines of responsibility lead to more efficient use of resources and earlier resolution of health problems. But for a health plan to create accountability, it has to determine which provider or provider organization should benefit from the financial upside of success, or bear the downside risk for poorly managing a patient’s care. Providers and provider organizations with attributed patients can realize significant performance-based bonuses, if the oversight efforts result in more efficient use of resources, better clinical documentation, or improvements in their overall panel’s health. The downside is that a physician can be assigned — and remains responsible for — attributed patients who never come into the practice, which occurs most often if the provider does not have a strong outreach program.

Attributing a patient is not a simple matter. Each has strengths and different implications for the type of marketing service you might offer a provider or organization. If your hospital or physician group holds multiple value-based contracts, focus your marketing efforts on the agreements that offer the most financial “upside,” based on the number of lives under that health plan contract or based on whether the clinical performance targets outlined in the agreement are achieveable.

While there are several attribution models, the most common are Prospective Attribution, Retrospective Attribution, and Geography-Based Attribution. As a marketer, the outreach strategies and tactics you recommend may differ, depending on the the attribution method.

The retrospective approach relies on the patient’s visit history (sometimes called visit-based attribution). The patient is attributed to the physician or provider organization the patient went to most frequently. In some cases, that attribution may be to a specialist, rather than a PCP. This rear-view mirror approach has the advantage of retrospective accuracy, but also the weakness of assuming the patients’ behavior in the coming year can be based on their behavior in the prior year. As a marketer, your goal is to solidfy a relationship such that the patient would be strongly predisposed to returning.

In a prospective attribution model, the health plan will assign the patient to a provider or provider organization, with the expectation the provider will reach out to the patient to create initial and ongoing engagement. While the provider has clarity about who they are responsible for, patients may not respond to that outreach. As a marketer, your opportunity is to make getting the first appointment easy and the experience pleasant, so they do not feel a need to go elsewhere.

A geography-based attribution is an approach that assigns patients to nearby providers, often at the ZIP code level. The proximity of the provider’s office to the patient’s residence can be attractive to many consumers, increasing the odds the patient will remain with that practice. The weakness in this model is that it does not take into account the actual health needs of the patient who may need to see a specialist more frequently than a PCP. Geography-based marketing is a natural fit for most marketers, both in the real world or digital world.

As you execute upon this year’s open enrollment outreach, open a discussion with your contracting team about value-based agreements and the attribution models used. It may help frame some of the activities you pursue after the new year.

Healthcare Marketing Messaging: Science Is a Cornerstone of Health

As lawmakers in California debated tightening vaccination requirements for schoolchildren, a protestor threw a menstrual cup with red liquid across the Senate chamber. Although that person’s goal was to disrupt a vote on the bill, it became law. The anti-vax movement is a sign of a larger issue facing healthcare.

In September, as lawmakers in California debated a proposed new law to tighten vaccination requirements for schoolchildren, a protestor threw a menstrual cup with red liquid across the Senate chamber. Although that person’s goal was to disrupt a vote on the bill, it was passed and signed into law. The anti-vaccine movement is one sign of a larger issue facing healthcare — growing public mistrust of science. This wave of doubt should concern all who work in healthcare.

Science is foundational to healthcare.

Yes, compassion in healthcare is essential. Yes, health insurance is an important mechanism to provide access. And yes, the cost of care will continue to challenge state and federal budgets. But what is the future of healthcare, if we turn away from science?

September also marks the annual Rally for Medical Research, an event where scientists from across the country gather in Washington, D.C., to urge lawmakers to increase funding for the National Institutes for Health (NIH). Each year, the NIH invests nearly $40 billion in the pursuit of basic, translational, and applied science through grants to more than 2,500 universities, medical schools, and research centers. Lives are saved, improved, and extended with the scientific knowledge developed by this financial support.

What Healthcare Marketers Need to Ask Patients and Why

When we show up to a doctor’s office or hospital as patients, we expect there to be a treatment for whatever ails us. It’s easy to forget that today’s commonplace treatments were developed by the application of science to the human condition. So when we begin accusing pediatricians of harming children with vaccines, or denying that climate change is real, or mocking the science that tells us that too many chemicals are entering our water and food sources — we are harming ourselves. The emotional satisfaction we get from snarkiness is short-lived, but its implications for science and medicine are much longer. Will politicians continue to support scientific investment, if a growing segment of our population doubts its validity?

No one is suggesting that we should have blind faith in science and medicine. There is a need for healthy skepticism in all things. Research is fundamentally a way of challenging conventional wisdom, but is based on a process that physicist Richard Feynman once described as “a way of not fooling ourselves.” The scientific process — based on repeatability by different teams with a peer-review process — is the way to differentiate between what we believe to be true and what is demonstrably true.

Today’s polarization is driven by many factors — economic, political, and belief systems. In healthcare, clashes over health insurance, access to care, and its cost, pale in importance to a more fundamental disturbing trend: Do we still believe in science? The treatments that will cure cancer, prevent Alzheimer’s, and reverse heart disease will depend on our answer.

Should Marketers Be Taking a Pass on Hard-hitting Sponsorships?

As a healthcare marketer, you wear many hats. One is “generate brand awareness.” How and where you choose to elevate your brand — including sponsorships — is a reflection of your organization, your audiences, a strategic analysis of pros and cons, and shifting societal perspectives.

As a healthcare marketer, you wear many hats. One is “generate brand awareness.” How and where you choose to elevate your brand — including sponsorships — is a reflection of your organization, your audiences, a strategic analysis of pros and cons, and shifting societal perspectives. So when Children’s Health of Texas put its name on a high school football stadium, the sponsorship raised some eyebrows.

Football is a huge part of life in Texas. Having grown up there, I understand the proper construction of a three-day weekend: Friday is high school game day, Saturday is for college, and Sunday/Monday is pro-ball. Putting your brand name on a stadium is a marketer’s dream. I’ve had that dream, too.

A few years ago, the decision to put a healthcare brand on a football stadium wouldn’t have attracted much attention. Since then, however, the connection between football concussions, traumatic brain injuries, and chronic traumatic encephalopathy (CTE) has become clear. The NFL uneasily acknowledged such a link in 2016. Other studies have shown that younger players are also susceptible to brain injury from contact sports at the college and high school levels. And parents are paying attention. The National Federation of State High School Associations reports participation in high school football has declined by 6.1% over the last decade, even as participation in other sports has grown. Other studies show even sharper declines in participation in youth football. Some of the decline is attributable to rising parental awareness about the link between hard-hitting contact sports and CTE.

So is this where a children’s healthcare brand should invest $2.5 million for a title sponsorship?

I am certain the decision to brand a football stadium was made with the best of intentions. It’s a high-visibility play, intended to create an affinity for the health system among parents as it expands its footprint. But in addition to securing eyeballs and mentions, brand placement is also about telegraphing organizational values and being mindful about clinical evidence. Will this sponsorship be paired with an equally visible effort to educate the public about how to minimize concussion risk?

To be sure, football is not going away. Athletes who excel at it become local celebrities, can get into stellar college programs and even dream of being in the NFL. Those who choose to play it should be able to do so. Brands associated with it, and other sports, often do well by association. But this is a tricky landscape for healthcare marketers.

Societal norms evolve. What would have been an easy decision a few years back may no longer be your best fit for a multi-year contract, moving forward. Ideally, brand placements position your organization as an exemplar of heightened conscience, as well as enduring core values. Only time will tell if the decision by Children’s Health of Texas struck the right balance with its audiences.

As you evaluate contract renewals or new sponsorship agreements, look beyond the sheer number of eyeballs who might see your brand. There are many ways to draw those eyeballs to your organization.

A marketer’s job is not to seize upon a high-profile promotional opportunity just because the cost-per-impression pencils out and you have the budget. The job is to choose sponsorships through a strategic lens.

Sponsorships, especially title sponsorships, should be chosen in the context of longer-term societal shifts and the values of the workforce in your organization — especially in healthcare.

Healthcare Marketers, Start Your Push for Annual Wellness Visits Now

As we enter the fall, healthcare marketers should be starting their push for Medicare enrollees to schedule an Annual Wellness Visit. Unlike an appointment for a specific ailment, the Annual Wellness Visit is a longer-than-usual appointment, centered on a conversation between patient and provider.

As we enter the fall, healthcare marketers should be starting their push for Medicare enrollees to schedule an Annual Wellness Visit.

Unlike an appointment for a specific ailment, the Annual Wellness Visit is a longer-than-usual appointment, centered on a conversation between patient and provider. Self-reported issues, such as feelings of depression or cognition difficulty, coupled with direct observations by the provider, allow for better monitoring of concerns, as well as a more complete clinical record.

This matters to health plans with Medicare Advantage enrollees, as well as provider groups who care for them, because better documentation means a more accurate risk-score assigned to the individual enrollee. Patients with multiple conditions often require more extensive monitoring than healthier patients. In recognition of that additional effort, the federal government applies a risk-score adjustment to the fixed monthly payment (capitation) paid to the Medicare Advantage plan. This is intended to encourage care management interventions that can improve the patient’s health.

Medicare Advantage plans, in turn, often offer bonuses to medical groups and providers that have a high percentage of completed Annual Wellness Visits among eligible patients. If your organization has a large number of Medicare patients, you’ll generally find that at least one-third of them are enrolled through a Medicare Advantage plan. The incentive revenue to your organization from the health plan for completed Annual Wellness Visits can be significant.

Although the risk-adjustment model of payment applies only to Medicare Advantage plans, the Annual Wellness Visit itself is a covered benefit for all Medicare patients.

There are three challenges when promoting Annual Wellness Visits:

  • Encouraging a person to see their provider when they are feeling fine. In general, people go to the doctor when they have a specific medical complaint. In contrast, the Annual Wellness Visit is not a visit for diagnosis and treatment, but for a conversation that leads to improved care on subsequent visits. Annual Wellness Visits can be performed by a physician, nurse practitioner, registered dietician, or other medical professionals under a doctor’s supervision.
  • Ensuring the patient knows to ask for an Annual Wellness Visit rather a different type of visit when making the appointment. This matters, because Annual Wellness Visits are longer than other types of appointments, so the number of available scheduling slots may be fewer. Annual Wellness Visits also have no co-pays from the patient, but the patient will be asked for a co-pay if the appointment is incorrectly classified.
  • Communicating urgency to make the appointment before end-of-year. Although a patient can take advantage of this annual benefit on a rolling 12-month calendar, the provider has to log the appointment by close-of-business on December 31 for it to impact upcoming risk-adjusted payments. (Thus, any incentives offered by the plan to your organization also will have a 12/31 cut-off.)

Despite these challenges, promotion of Annual Wellness Visits can benefit patients, plans, and providers, alike.

Why Google’s SEO Strategy May Drive You Back to Digital Display

Bit by bit, Google has been changing the terms of its SEO strategy deal with healthcare marketers. Google’s strategy is shifting away from matchmaker to one of being a destination in and of itself, with fewer hand-offs necessary to your non-e-commerce site.

Bit by bit, Google has been changing the terms of its SEO strategy deal with healthcare marketers.

Health systems produced content and then made it “findable” by following established search engine optimization (SEO) techniques, in exchange for greater visibility when Google’s users plugged in related search terms. With more than 60% market share, Google’s importance as a matchmaker between content and curiosity could not be overstated.

But Google’s strategy is shifting away from matchmaker to one of being a destination in and of itself, with fewer hand-offs necessary to your non-e-commerce site. As your organic traffic plateaus, marketers will be forced to re-balance their digital tactics, just to hold onto the same user volume.

Google’s changing approach is based on old trends, as well as new ones. Marketers have long known that the longer a user spends on a site, the more opportunity there is to capture value from the visit. Google now leverages that logic for its benefit. The more information previewed in the top-level results, the more likely it is that the user’s question will be satisfied without the need to click through your site. The results from voice-based searches are even more succinct and less subject to commercialization (at this point).

What Healthcare Marketers Can Do

Are you unsure if this trend applies to your hospital?

Do a condition-based search, relevant to your facility, on a desktop. The results page probably starts with knowledge panels and instant answers, a map with showing facilities like yours, followed by paid ads, and then organic results — where SEO lives.

This hierarchy is more pronounced on mobile. Google depends on your site to serve up information that it compiles and displays in an at-a-glance format, regardless of device. A substantial number of searches relevant to your core content can be addressed, without ever registering on your analytics as a site visit. The irony is you can be getting better at SEO; especially with speakable schema, but not see the growth in traffic you’ve come to expect.

So, do you abandon SEO efforts? No. Digital queries in all forms will continue to increase, and competitors will not sit still. Quality content will retain its value, but likely needs additional behind-the-scenes mark-ups to be optimized.

Beyond that, you may need to revise your assumptions about traffic volume that will be produced by organic results and offset that volume loss with traffic generated from targeted outbound display ads. Of course, this has implications for your budget and audience mix.

The good news is that digital display on reputable outlets can give you the targeting and frequency levels necessary to generate awareness. And, creativity will once again become the focus of display ad development to pique the viewer’s interests and earn the click.

Like so many things, what was old is new again.

From ACA to Medicare: 5 Answers to Healthcare Marketers’ Legal Questions About Insurance

As healthcare marketers and communications professionals, this swirl of forces hits close to home. Are you able to describe the various paths of reform to internal or external audiences?

In the spring of 2010, healthcare marketers saw the Patient Protection and Affordable Care Act (ACA), nicknamed ObamaCare, become law. It was the largest expansion of health insurance coverage since the establishment of Medicare and Medicaid in 1965. More than 50 years have passed since healthcare became more accessible, yet it remains a fiercely debated topic among politicians and is now the No. 1 concern among voters, according to a new poll from RealClear Opinion Research.

The tug-of-war between those who view healthcare as a guaranteed right and those who believe the government should have a minimal role is shaping up to be a driving force in the 2020 election. The processes used to “right-size” the government’s role shows we remain deeply conflicted. Court cases in different jurisdictions return victories and defeats to both sides. Voters generally approve Medicaid expansion when it’s on a state ballot, but elect federal representatives with divergent views. Why is this still so complicated?

The U.S., which has the world’s most powerful armed forces, spends 3.6% of its gross domestic product (GDP) on the military. Contrast that with the 18% of GDP spent on healthcare, and you start to get a sense of the scale of the industry and the Rubik’s Cube nature of how its pieces depend on each other. Those who view healthcare as a matter of seeing the doctor when you are sick tend to see the upside in expanding coverage. Those who think of it in economic terms tend to worry about potential disruption to jobs, given that healthcare is the largest source of employment in many towns. And those who view it as a commodity tend to think the marketplace should be left alone to sort it out.

As healthcare marketers and communications professionals, this swirl of forces hits close to home. Are you able to describe the various paths of reform to internal or external audiences?

  • The ACA (today’s status quo): For Americans who do not receive health insurance through their employer, the ACA removed restrictions on individual policies, such as exclusions for pre-existing conditions, lifetime limitations on benefits, and widely divergent premiums based on your health. Of course, the ACA also set up online exchanges where you could see if you qualify for certain subsidies to help you purchase different levels of gold, silver, or bronze coverage. Some people objected to the “individual mandate” that penalized taxpayers as a means of encouraging them to get coverage. Since its passage, the penalty for the mandate has been reduced to $0.
  • Single-Payer: Single-payer refers to the federal government reimbursing physicians and hospitals for services provided to patients, but doesn’t explicitly tie the reimbursement amounts to those of an existing program, such as Medicare or Medicaid. The uncertainty creates financial uncertainty for providers. Single-payer would, for the most part, eliminate the role of health insurance companies, which advocates believe would save money on administrative “waste” and opponents see as removing choice from the marketplace. Consumers who have “skimpy” health coverage might have more services covered under single payer, while those with richer benefits through commercial insurance might have fewer services covered.
  • Medicare-for-All (multiple flavors): Medicare-for-All is an expansion of an existing federal program accepted by almost all providers. Several proposals generally fall under the “Medicare for All” moniker, making it more complex to sort out. The name gives the impression the covered benefits would be similar to original Medicare parts A&B, but most proposals envision benefits like those available through Medicare Advantage, with benefits for vision, dental, and prescription drugs. Some proposals use traditional Medicare as a starting point for calculating reimbursements, while others use a more ambitious “global payments” approach for hospitals and standard rates for other types of providers. Consumers could purchase supplemental insurance to access services that are not covered. There would be no monthly premiums because tax revenues would cover costs. Medicare, Medicaid, and CHIP would be discontinued in favor of Medicare-for-All.
  • Medicare Buy-in: Medicare Buy-in is a smaller expansion of Medicare than envisioned under Medicare-for-All. This proposal would allow people 50 years old and over to pay a premium for the coverage provided under traditional Medicare or Medicare Advantage. The buy-in premium would be expected to cover 100% of administrative and benefit costs, although the enrollee may qualify for subsidies that bring down monthly premiums. Consumers could also purchase supplemental coverage, preserving a role for commercial insurance companies for that segment, as well as for younger consumers. Reimbursement rates for providers would mimic Medicare payment rates.
  • Universal Coverage: This is a goal rather than a pre-defined approach. As the name implies, Universal Coverage means everyone has access to healthcare, but it does not necessarily mean all services would be covered and it does not specify which of the above methods would be used to achieve it. In some countries, Universal Coverage also means that the government would control pricing, which critics say leads to an overall decline in the quality of care and advocates view as being more socially equitable.

As the debate over healthcare heats up — yet again — it may produce confusion and fear among people who have come to depend on specific programs, even if those programs have well-known flaws. Real change isn’t likely until after the 2020 elections, and the direction of that change will depend on who voters send to D.C. to represent them. In the meantime, be prepared to answer a lot of questions from worried patients.